Salivary Gland Diseases: Detailed Guide

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 27.09.2026

Anatomy and function

The parotid gland lies in front of and below the ear, behind the jawbone; its duct opens on the inside of the cheek, level with the upper second molar. The facial nerve, which works the muscles of the face, passes through the parotid gland and branches within it; this is why protecting this nerve is the most important issue in parotid surgery. The submandibular gland lies beneath the jawbone, next to the lingual nerve; its duct opens under the tongue, at the front of the floor of the mouth. The sublingual gland lies in the floor of the mouth under the tongue. The minor salivary glands are distributed throughout the lining of the lips, cheeks, palate and tongue.

With its digestive enzymes, protective antibodies and minerals, saliva repairs the tooth surface, keeps the oral flora in balance, lubricates food for swallowing and makes the sense of taste possible. When the flow decreases, dry mouth, tooth decay, difficulty swallowing and gland infections appear.

Obstructive diseases: stones, strictures and cysts

Stones (sialolithiasis): A stone starts as a mineral deposit inside the duct and grows over the years. Stones are more common in the submandibular gland because its duct runs upwards over a long course and its saliva is thicker and richer in calcium. Swelling and pain with meals are typical; if the stone is close to the duct opening, it may be felt in the floor of the mouth. Ultrasound shows the great majority of stones; in doubtful cases, a low-dose CT scan or direct visualisation by passing a camera into the duct (sialendoscopy) is performed.

Duct stricture: Narrowing of the duct can develop after previous infections, a stone or radiotherapy; it causes recurrent swelling without a stone. With sialendoscopy the stricture can be widened with a balloon.

Mucocele and ranula: These are saliva-filled cysts formed when the duct of a minor salivary gland becomes blocked. They appear as a small, clear blister on the lip (mucocele) or as a bluish swelling in the floor of the mouth (ranula); treatment is removal of the cyst together with the gland involved.

Infections

Acute bacterial sialadenitis: This mostly affects the parotid and develops when saliva flow is reduced (dehydration, the post-operative period, older age, medicines such as diuretics and antidepressants). The gland is painful, hard and red; pus comes from the duct opening, and fever may accompany it. Treatment consists of antibiotics, plenty of fluids, warm compresses, gland massage and measures that increase saliva flow. If an abscess develops, it is drained under ultrasound guidance.

Viral sialadenitis: The mumps virus causes painful swelling of both parotid glands and clears up on its own; thanks to vaccination it is rare today. Some other viruses can also enlarge the glands temporarily.

Chronic recurrent sialadenitis: Frequently recurring attacks cause permanent damage to the gland tissue; an underlying stone or stricture is looked for. Recurrent parotitis seen in children usually resolves on its own around puberty; during attacks, supportive treatment is given and, if necessary, the duct is flushed with sialendoscopy.

Systemic and autoimmune causes

Sjögren’s syndrome is a disease in which the immune system attacks the salivary and tear glands, causing dry mouth and dry eyes; the glands may enlarge on both sides without pain, and because of the risk of lymphoma it is monitored regularly. IgG4-related disease and sarcoidosis can enlarge the glands painlessly. Sialadenosis is a soft, painless enlargement of the parotid glands on both sides linked to diabetes, alcohol use, eating disorders and certain medicines. In these conditions the diagnosis is made with blood tests, ultrasound and, when needed, a biopsy of a minor salivary gland from the lip; treatment is planned together with the relevant departments (rheumatology, internal medicine).

Tumours

Salivary gland tumours account for approximately 3–6% of head and neck tumours; most are located in the parotid. There is a simple rule: the smaller the gland, the higher the likelihood of malignancy. About 80% of parotid tumours and about half of submandibular gland tumours are benign, whereas the majority of minor salivary gland tumours are malignant.

Benign tumours: The most common is pleomorphic adenoma; it grows slowly and is painless, but if left untreated it continues to grow over the years and a small proportion undergo malignant transformation. Warthin tumour is seen mostly in older people and in smokers, can sometimes occur on both sides, and has a very low risk of turning malignant.

Malignant tumours: Mucoepidermoid carcinoma and adenoid cystic carcinoma are the most common. Rapid growth, pain, adhesion to or ulceration of the skin, weakness of the facial nerve, enlarged lymph nodes in the neck and restricted mouth opening are warning signs of a malignant tumour. However, a significant proportion of malignant tumours look the same as benign ones at first; for this reason every lump is assessed with a biopsy.

Diagnostic process

Examination: The size, consistency and mobility of the gland and the lump, the character of the saliva coming from the duct opening, the function of the facial nerve and the lymph nodes of the neck are assessed; the floor of the mouth is examined with both hands to look for stones.

Ultrasound: This is the first-line imaging test; it shows stones, duct dilatation, the margins of a lump and the lymph nodes of the neck, and guides biopsy.

Fine-needle aspiration biopsy: A cell sample is taken from the lump with a fine needle; it distinguishes with high accuracy whether a tumour is benign or malignant and determines the surgical plan. Taking a piece by cutting into the lump (incisional biopsy) is not performed, because it can seed tumour cells into the surrounding tissue and damage the facial nerve.

MRI and CT: These are requested for deep-seated, large or suspected malignant lumps, to show the boundaries of the tumour, its relationship to the facial nerve and any spread to the neck.

Sialendoscopy: With a camera thinner than one millimetre advanced through the duct opening, the duct system is viewed directly; stones, strictures and plugs can be treated in the same session.

Treatment

For stones and blockages

Small stones close to the duct opening may pass with measures that increase saliva flow and with massage. Stones visible from inside the mouth are removed under local anaesthesia by opening the duct. For deeper stones, the stone is caught with a basket via sialendoscopy or broken up and removed; this method preserves the gland. For very large stones embedded within the gland, or when the gland tissue has been damaged by recurrent infection, removal of the gland may be necessary.

Surgery for tumours

For parotid tumours, the standard treatment is removal of the relevant part of the gland with a margin of healthy tissue left around the tumour (superficial or partial parotidectomy); for deep-seated tumours the whole gland is removed. The most important stage of the operation is finding and protecting the branches of the facial nerve; for this purpose, a nerve monitor is used during surgery. The incision starts in front of the ear and is hidden in the hairline and a neck crease. The submandibular gland is removed as a whole through an incision below the jaw; here the structures that must be protected are the nerve branch that moves the lower lip and the sensory and motor nerves of the tongue. For malignant tumours, depending on the type and stage of the tumour, removal of the neck lymph nodes and post-operative radiotherapy are added.

After surgery and possible problems

The hospital stay is usually one to two days; the drain is removed within a few days. After parotidectomy, temporary weakness of the facial nerve is seen in some patients and mostly resolves within weeks; permanent damage is rare in operations for benign tumours. Numbness of the earlobe is common and usually temporary. Frey syndrome is a condition that appears months after surgery as sweating and flushing of the cheek while eating, and is easily treated with botulinum toxin. A collection of saliva or a salivary fistula mostly resolves with dressings and pressure. Removing one gland does not cause dry mouth; the remaining glands produce enough saliva.

Follow-up

After a benign tumour has been removed, examinations a few times in the first year and yearly thereafter are sufficient; in pleomorphic adenoma recurrence is rare but can appear late, so long-term follow-up is recommended. For malignant tumours, examinations and imaging are more frequent in the first years. In patients with stones, diet and fluid intake are adjusted; if complaints recur, the duct is assessed again.

Frequently asked questions

Is every salivary gland lump cancer? No; the great majority of lumps in the parotid are benign. However, because benign tumours also grow and some can change over time, the diagnosis is made with fine-needle biopsy and they are usually removed.

Will a stone pass on its own? Small stones close to the duct opening may pass with plenty of fluids, sour foods and massage. Stones that do not pass within a few weeks or that cause infection require intervention.

Will my mouth become dry if a gland is removed? No. Removing one of the six major glands does not noticeably reduce the amount of saliva.

Will the surgical scar be visible? The parotid incision is placed along the crease in front of the ear and the hairline, and the submandibular incision in a neck crease; once healed, they usually go unnoticed.

The area in front of my child’s ear swells from time to time – what should I do? Recurrent parotitis in children is mostly a condition that resolves on its own; even so, each attack should be examined and a stone or other cause ruled out.

If I have had the mumps vaccine, can I still get a gland infection? The vaccine protects against mumps; since bacterial infection, stones and tumours are unrelated to the vaccine, these diseases can still occur.

This article is for general information; please consult your physician for diagnosis and treatment.